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Mieke L Van Driel - One of the best experts on this subject based on the ideXlab platform.
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oral Antifungal Medication for toenail onychomycosis
Cochrane Database of Systematic Reviews, 2017Co-Authors: Sanne Kreijkampkaspers, Kate Hawke, Linda Guo, George Kerin, Sally E M Bellsyer, Parker Magin, Mieke L Van DrielAbstract:Background Fungal infection of the toenails, also called onychomycosis, is a common problem that causes damage to the nail's structure and physical appearance. For those severely affected, it can interfere with normal daily activities. Treatment is taken orally or applied topically; however, traditionally topical treatments have low success rates due to the nail's physical properties. Oral treatments also appear to have shorter treatment times and better cure rates. Our review will assist those needing to make an evidence-based choice for treatment. Objectives To assess the effects of oral Antifungal treatments for toenail onychomycosis. Search methods We searched the following databases up to October 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). We sought to identify unpublished and ongoing trials by correspondence with authors and by contacting relevant pharmaceutical companies. Selection criteria RCTs comparing oral Antifungal treatment to placebo or another oral Antifungal treatment in participants with toenail onychomycosis, confirmed by one or more positive cultures, direct microscopy of fungal elements, or histological examination of the nail. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We included 48 studies involving 10,200 participants. Half the studies took place in more than one centre and were conducted in outpatient dermatology settings. The participants mainly had subungual fungal infection of the toenails. Study duration ranged from 4 months to 2 years. We assessed one study as being at low risk of bias in all domains and 18 studies as being at high risk of bias in at least one domain. The most common high-risk domain was 'blinding of personnel and participants'. We found high-quality evidence that terbinafine is more effective than placebo for achieving clinical cure (risk ratio (RR) 6.00, 95% confidence interval (CI) 3.96 to 9.08, 8 studies, 1006 participants) and mycological cure (RR 4.53, 95% CI 2.47 to 8.33, 8 studies, 1006 participants). Adverse events amongst terbinafine-treated participants included gastrointestinal symptoms, infections, and headache, but there was probably no significant difference in their risk between the groups (RR 1.13, 95% CI 0.87 to 1.47, 4 studies, 399 participants, moderate-quality evidence). There was high-quality evidence that azoles were more effective than placebo for achieving clinical cure (RR 22.18, 95% CI 12.63 to 38.95, 9 studies, 3440 participants) and mycological cure (RR 5.86, 95% CI 3.23 to 10.62, 9 studies, 3440 participants). There were slightly more adverse events in the azole group (the most common being headache, flu-like symptoms, and nausea), but the difference was probably not significant (RR 1.04, 95% CI 0.97 to 1.12; 9 studies, 3441 participants, moderate-quality evidence). Terbinafine and azoles may lower the recurrence rate when compared, individually, to placebo (RR 0.05, 95% CI 0.01 to 0.38, 1 study, 35 participants; RR 0.55, 95% CI 0.29 to 1.07, 1 study, 26 participants, respectively; both low-quality evidence). There is moderate-quality evidence that terbinafine was probably more effective than azoles for achieving clinical cure (RR 0.82, 95% CI 0.72 to 0.95, 15 studies, 2168 participants) and mycological cure (RR 0.77, 95% CI 0.68 to 0.88, 17 studies, 2544 participants). There was probably no difference in the risk of adverse events (RR 1.00, 95% CI 0.86 to 1.17; 9 studies, 1762 participants, moderate-quality evidence) between the two groups, and there may be no difference in recurrence rate (RR 1.11, 95% CI 0.68 to 1.79, 5 studies, 282 participants, low-quality evidence). Common adverse events in both groups included headache, viral infection, and nausea. Moderate-quality evidence shows that azoles and griseofulvin probably had similar efficacy for achieving clinical cure (RR 0.94, 95% CI 0.45 to 1.96, 5 studies, 222 participants) and mycological cure (RR 0.87, 95% CI 0.50 to 1.51, 5 studies, 222 participants). However, the risk of adverse events was probably higher in the griseofulvin group (RR 2.41, 95% CI 1.56 to 3.73, 2 studies, 143 participants, moderate-quality evidence), with the most common being gastrointestinal disturbance and allergic reaction (in griseofulvin-treated participants) along with nausea and vomiting (in azole-treated participants). Very low-quality evidence means we are uncertain about this comparison's impact on recurrence rate (RR 4.00, 0.26 to 61.76, 1 study, 7 participants). There is low-quality evidence that terbinafine may be more effective than griseofulvin in terms of clinical cure (RR 0.32, 95% CI 0.14 to 0.72, 4 studies, 270 participants) and mycological cure (RR 0.64, 95% CI 0.46 to 0.90, 5 studies, 465 participants), and griseofulvin was associated with a higher risk of adverse events, although this was based on low-quality evidence (RR 2.09, 95% CI 1.15 to 3.82, 2 studies, 100 participants). Common adverse events included headache and stomach problems (in griseofulvin-treated participants) as well as taste loss and nausea (in terbinafine-treated participants). No studies addressed recurrence rate for this comparison. No study addressed quality of life. Authors' conclusions We found high-quality evidence that compared to placebo, terbinafine and azoles are effective treatments for the mycological and clinical cure of onychomycosis, with moderate-quality evidence of excess harm. However, terbinafine probably leads to better cure rates than azoles with the same risk of adverse events (moderate-quality evidence). Azole and griseofulvin were shown to probably have a similar effect on cure, but more adverse events appeared to occur with the latter (moderate-quality evidence). Terbinafine may improve cure and be associated with fewer adverse effects when compared to griseofulvin (low-quality evidence). Only four comparisons assessed recurrence rate: low-quality evidence found that terbinafine or azoles may lower the recurrence rate when compared to placebo, but there may be no difference between them. Only a limited number of studies reported adverse events, and the severity of the events was not taken into account. Overall, the quality of the evidence varied widely from high to very low depending on the outcome and comparison. The main reasons to downgrade evidence were limitations in study design, such as unclear allocation concealment and randomisation as well as lack of blinding.
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oral Antifungal Medication for toenail onychomycosis protocol
Cochrane Database of Systematic Reviews, 2012Co-Authors: Sanne Kreijkampkaspers, Sally E M Bellsyer, Parker Magin, Mieke L Van DrielAbstract:This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the benefits and harms of oral Antifungal treatments for toenail onychomycosis.
Sally E M Bellsyer - One of the best experts on this subject based on the ideXlab platform.
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oral Antifungal Medication for toenail onychomycosis
Cochrane Database of Systematic Reviews, 2017Co-Authors: Sanne Kreijkampkaspers, Kate Hawke, Linda Guo, George Kerin, Sally E M Bellsyer, Parker Magin, Mieke L Van DrielAbstract:Background Fungal infection of the toenails, also called onychomycosis, is a common problem that causes damage to the nail's structure and physical appearance. For those severely affected, it can interfere with normal daily activities. Treatment is taken orally or applied topically; however, traditionally topical treatments have low success rates due to the nail's physical properties. Oral treatments also appear to have shorter treatment times and better cure rates. Our review will assist those needing to make an evidence-based choice for treatment. Objectives To assess the effects of oral Antifungal treatments for toenail onychomycosis. Search methods We searched the following databases up to October 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). We sought to identify unpublished and ongoing trials by correspondence with authors and by contacting relevant pharmaceutical companies. Selection criteria RCTs comparing oral Antifungal treatment to placebo or another oral Antifungal treatment in participants with toenail onychomycosis, confirmed by one or more positive cultures, direct microscopy of fungal elements, or histological examination of the nail. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We included 48 studies involving 10,200 participants. Half the studies took place in more than one centre and were conducted in outpatient dermatology settings. The participants mainly had subungual fungal infection of the toenails. Study duration ranged from 4 months to 2 years. We assessed one study as being at low risk of bias in all domains and 18 studies as being at high risk of bias in at least one domain. The most common high-risk domain was 'blinding of personnel and participants'. We found high-quality evidence that terbinafine is more effective than placebo for achieving clinical cure (risk ratio (RR) 6.00, 95% confidence interval (CI) 3.96 to 9.08, 8 studies, 1006 participants) and mycological cure (RR 4.53, 95% CI 2.47 to 8.33, 8 studies, 1006 participants). Adverse events amongst terbinafine-treated participants included gastrointestinal symptoms, infections, and headache, but there was probably no significant difference in their risk between the groups (RR 1.13, 95% CI 0.87 to 1.47, 4 studies, 399 participants, moderate-quality evidence). There was high-quality evidence that azoles were more effective than placebo for achieving clinical cure (RR 22.18, 95% CI 12.63 to 38.95, 9 studies, 3440 participants) and mycological cure (RR 5.86, 95% CI 3.23 to 10.62, 9 studies, 3440 participants). There were slightly more adverse events in the azole group (the most common being headache, flu-like symptoms, and nausea), but the difference was probably not significant (RR 1.04, 95% CI 0.97 to 1.12; 9 studies, 3441 participants, moderate-quality evidence). Terbinafine and azoles may lower the recurrence rate when compared, individually, to placebo (RR 0.05, 95% CI 0.01 to 0.38, 1 study, 35 participants; RR 0.55, 95% CI 0.29 to 1.07, 1 study, 26 participants, respectively; both low-quality evidence). There is moderate-quality evidence that terbinafine was probably more effective than azoles for achieving clinical cure (RR 0.82, 95% CI 0.72 to 0.95, 15 studies, 2168 participants) and mycological cure (RR 0.77, 95% CI 0.68 to 0.88, 17 studies, 2544 participants). There was probably no difference in the risk of adverse events (RR 1.00, 95% CI 0.86 to 1.17; 9 studies, 1762 participants, moderate-quality evidence) between the two groups, and there may be no difference in recurrence rate (RR 1.11, 95% CI 0.68 to 1.79, 5 studies, 282 participants, low-quality evidence). Common adverse events in both groups included headache, viral infection, and nausea. Moderate-quality evidence shows that azoles and griseofulvin probably had similar efficacy for achieving clinical cure (RR 0.94, 95% CI 0.45 to 1.96, 5 studies, 222 participants) and mycological cure (RR 0.87, 95% CI 0.50 to 1.51, 5 studies, 222 participants). However, the risk of adverse events was probably higher in the griseofulvin group (RR 2.41, 95% CI 1.56 to 3.73, 2 studies, 143 participants, moderate-quality evidence), with the most common being gastrointestinal disturbance and allergic reaction (in griseofulvin-treated participants) along with nausea and vomiting (in azole-treated participants). Very low-quality evidence means we are uncertain about this comparison's impact on recurrence rate (RR 4.00, 0.26 to 61.76, 1 study, 7 participants). There is low-quality evidence that terbinafine may be more effective than griseofulvin in terms of clinical cure (RR 0.32, 95% CI 0.14 to 0.72, 4 studies, 270 participants) and mycological cure (RR 0.64, 95% CI 0.46 to 0.90, 5 studies, 465 participants), and griseofulvin was associated with a higher risk of adverse events, although this was based on low-quality evidence (RR 2.09, 95% CI 1.15 to 3.82, 2 studies, 100 participants). Common adverse events included headache and stomach problems (in griseofulvin-treated participants) as well as taste loss and nausea (in terbinafine-treated participants). No studies addressed recurrence rate for this comparison. No study addressed quality of life. Authors' conclusions We found high-quality evidence that compared to placebo, terbinafine and azoles are effective treatments for the mycological and clinical cure of onychomycosis, with moderate-quality evidence of excess harm. However, terbinafine probably leads to better cure rates than azoles with the same risk of adverse events (moderate-quality evidence). Azole and griseofulvin were shown to probably have a similar effect on cure, but more adverse events appeared to occur with the latter (moderate-quality evidence). Terbinafine may improve cure and be associated with fewer adverse effects when compared to griseofulvin (low-quality evidence). Only four comparisons assessed recurrence rate: low-quality evidence found that terbinafine or azoles may lower the recurrence rate when compared to placebo, but there may be no difference between them. Only a limited number of studies reported adverse events, and the severity of the events was not taken into account. Overall, the quality of the evidence varied widely from high to very low depending on the outcome and comparison. The main reasons to downgrade evidence were limitations in study design, such as unclear allocation concealment and randomisation as well as lack of blinding.
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oral Antifungal Medication for toenail onychomycosis protocol
Cochrane Database of Systematic Reviews, 2012Co-Authors: Sanne Kreijkampkaspers, Sally E M Bellsyer, Parker Magin, Mieke L Van DrielAbstract:This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the benefits and harms of oral Antifungal treatments for toenail onychomycosis.
Ragnar Rylander - One of the best experts on this subject based on the ideXlab platform.
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Clinical Study Sarcoidosis Treatment with Antifungal Medication: A Follow-Up
2020Co-Authors: Marjeta Terielj, Barbara Salobir, Mirjana Zupancic, Ragnar Rylander, Sebastian L JohnstonAbstract:Introduction. The aim of the study was to compare treatment of sarcoidosis with Antifungal or corticosteroid Medication. Methods. In patients with sarcoidosis Antifungal Medication ( = 29), corticosteroids ( = 21) or a combination ( = 27) was given. Nine patients allotted to Antifungal Medication were later given corticosteroids because of the lack of regression of the disease. Xray scores for the severity of granuloma infiltration were determined. Chitotriosidase and angiotensin converting enzyme were determined. The time in months till remission was observed as well as the number of recurrences
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sarcoidosis treatment with Antifungal Medication a follow up
Pulmonary Medicine, 2014Co-Authors: Marjeta Tercelj, Barbara Salobir, Mirjana Zupancic, Ragnar RylanderAbstract:Introduction The aim of the study was to compare treatment of sarcoidosis with Antifungal or corticosteroid Medication. Methods In patients with sarcoidosis Antifungal Medication (n = 29), corticosteroids (n = 21) or a combination (n = 27) was given. Nine patients allotted to Antifungal Medication were later given corticosteroids because of the lack of regression of the disease. X-ray scores for the severity of granuloma infiltration were determined. Chitotriosidase and angiotensin converting enzyme were determined. The time in months till remission was observed as well as the number of recurrences.
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Antifungal Medication is efficient in the treatment of sarcoidosis
Therapeutic Advances in Respiratory Disease, 2011Co-Authors: Marjeta Tercelj, Barbara Salobir, Mirjana Zupancic, Ragnar RylanderAbstract:Objectives: Fungi have been suspected of contributing to the pathogenesis of sarcoidosis. A previous intervention study demonstrated an improvement in the clinical condition in 15 out of 18 patient...
Sanne Kreijkampkaspers - One of the best experts on this subject based on the ideXlab platform.
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oral Antifungal Medication for toenail onychomycosis
Cochrane Database of Systematic Reviews, 2017Co-Authors: Sanne Kreijkampkaspers, Kate Hawke, Linda Guo, George Kerin, Sally E M Bellsyer, Parker Magin, Mieke L Van DrielAbstract:Background Fungal infection of the toenails, also called onychomycosis, is a common problem that causes damage to the nail's structure and physical appearance. For those severely affected, it can interfere with normal daily activities. Treatment is taken orally or applied topically; however, traditionally topical treatments have low success rates due to the nail's physical properties. Oral treatments also appear to have shorter treatment times and better cure rates. Our review will assist those needing to make an evidence-based choice for treatment. Objectives To assess the effects of oral Antifungal treatments for toenail onychomycosis. Search methods We searched the following databases up to October 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). We sought to identify unpublished and ongoing trials by correspondence with authors and by contacting relevant pharmaceutical companies. Selection criteria RCTs comparing oral Antifungal treatment to placebo or another oral Antifungal treatment in participants with toenail onychomycosis, confirmed by one or more positive cultures, direct microscopy of fungal elements, or histological examination of the nail. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We included 48 studies involving 10,200 participants. Half the studies took place in more than one centre and were conducted in outpatient dermatology settings. The participants mainly had subungual fungal infection of the toenails. Study duration ranged from 4 months to 2 years. We assessed one study as being at low risk of bias in all domains and 18 studies as being at high risk of bias in at least one domain. The most common high-risk domain was 'blinding of personnel and participants'. We found high-quality evidence that terbinafine is more effective than placebo for achieving clinical cure (risk ratio (RR) 6.00, 95% confidence interval (CI) 3.96 to 9.08, 8 studies, 1006 participants) and mycological cure (RR 4.53, 95% CI 2.47 to 8.33, 8 studies, 1006 participants). Adverse events amongst terbinafine-treated participants included gastrointestinal symptoms, infections, and headache, but there was probably no significant difference in their risk between the groups (RR 1.13, 95% CI 0.87 to 1.47, 4 studies, 399 participants, moderate-quality evidence). There was high-quality evidence that azoles were more effective than placebo for achieving clinical cure (RR 22.18, 95% CI 12.63 to 38.95, 9 studies, 3440 participants) and mycological cure (RR 5.86, 95% CI 3.23 to 10.62, 9 studies, 3440 participants). There were slightly more adverse events in the azole group (the most common being headache, flu-like symptoms, and nausea), but the difference was probably not significant (RR 1.04, 95% CI 0.97 to 1.12; 9 studies, 3441 participants, moderate-quality evidence). Terbinafine and azoles may lower the recurrence rate when compared, individually, to placebo (RR 0.05, 95% CI 0.01 to 0.38, 1 study, 35 participants; RR 0.55, 95% CI 0.29 to 1.07, 1 study, 26 participants, respectively; both low-quality evidence). There is moderate-quality evidence that terbinafine was probably more effective than azoles for achieving clinical cure (RR 0.82, 95% CI 0.72 to 0.95, 15 studies, 2168 participants) and mycological cure (RR 0.77, 95% CI 0.68 to 0.88, 17 studies, 2544 participants). There was probably no difference in the risk of adverse events (RR 1.00, 95% CI 0.86 to 1.17; 9 studies, 1762 participants, moderate-quality evidence) between the two groups, and there may be no difference in recurrence rate (RR 1.11, 95% CI 0.68 to 1.79, 5 studies, 282 participants, low-quality evidence). Common adverse events in both groups included headache, viral infection, and nausea. Moderate-quality evidence shows that azoles and griseofulvin probably had similar efficacy for achieving clinical cure (RR 0.94, 95% CI 0.45 to 1.96, 5 studies, 222 participants) and mycological cure (RR 0.87, 95% CI 0.50 to 1.51, 5 studies, 222 participants). However, the risk of adverse events was probably higher in the griseofulvin group (RR 2.41, 95% CI 1.56 to 3.73, 2 studies, 143 participants, moderate-quality evidence), with the most common being gastrointestinal disturbance and allergic reaction (in griseofulvin-treated participants) along with nausea and vomiting (in azole-treated participants). Very low-quality evidence means we are uncertain about this comparison's impact on recurrence rate (RR 4.00, 0.26 to 61.76, 1 study, 7 participants). There is low-quality evidence that terbinafine may be more effective than griseofulvin in terms of clinical cure (RR 0.32, 95% CI 0.14 to 0.72, 4 studies, 270 participants) and mycological cure (RR 0.64, 95% CI 0.46 to 0.90, 5 studies, 465 participants), and griseofulvin was associated with a higher risk of adverse events, although this was based on low-quality evidence (RR 2.09, 95% CI 1.15 to 3.82, 2 studies, 100 participants). Common adverse events included headache and stomach problems (in griseofulvin-treated participants) as well as taste loss and nausea (in terbinafine-treated participants). No studies addressed recurrence rate for this comparison. No study addressed quality of life. Authors' conclusions We found high-quality evidence that compared to placebo, terbinafine and azoles are effective treatments for the mycological and clinical cure of onychomycosis, with moderate-quality evidence of excess harm. However, terbinafine probably leads to better cure rates than azoles with the same risk of adverse events (moderate-quality evidence). Azole and griseofulvin were shown to probably have a similar effect on cure, but more adverse events appeared to occur with the latter (moderate-quality evidence). Terbinafine may improve cure and be associated with fewer adverse effects when compared to griseofulvin (low-quality evidence). Only four comparisons assessed recurrence rate: low-quality evidence found that terbinafine or azoles may lower the recurrence rate when compared to placebo, but there may be no difference between them. Only a limited number of studies reported adverse events, and the severity of the events was not taken into account. Overall, the quality of the evidence varied widely from high to very low depending on the outcome and comparison. The main reasons to downgrade evidence were limitations in study design, such as unclear allocation concealment and randomisation as well as lack of blinding.
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oral Antifungal Medication for toenail onychomycosis protocol
Cochrane Database of Systematic Reviews, 2012Co-Authors: Sanne Kreijkampkaspers, Sally E M Bellsyer, Parker Magin, Mieke L Van DrielAbstract:This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the benefits and harms of oral Antifungal treatments for toenail onychomycosis.
Maristela Barbosa Portela - One of the best experts on this subject based on the ideXlab platform.
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candida spp in linear gingival erythema lesions in hiv infected children reports of six cases
Rio de Janeiro Dental Journal (Revista Científica do CRO-RJ), 2018Co-Authors: Maristela Barbosa Portela, Daniella Ferraz Cerqueira, Renato Vieira De Paiva, Adrielle Mangabeira Santos, Tamiris Ramos Vargas, Gloria Fernanda Barbosa De Araujo CastroAbstract:Introduction: Linear gingival erythema (LGE), formally referred to as HIV-gingivitis, is the most common form of HIV-associated periodontal disease in HIV-infected individuals These lesions have been recently evaluated as a possible form of erythematous oral candidosis, mainly caused by Candida albicans. Other species such as C. tropicalis, C. stellatoidea, C. krusei, C. parapsilosis, C. glabrata and C. dubliniensis, have also been identified in some HIV-infected subjects. Objective: This case report reveals the presence of typical LGE lesions in six HIV-infected children, and also investigates the etiologic agent through microbiological exams and correlates this oral manifestation with the patients’ systemic conditions. Case report: Microbiological analyses showed growth for Candida spp in all patients; all of whom had severe immunosuppression. However, the regression of lesions was noted after Antifungal Medication. Conclusion: The presence of LGE in pediatric patients with AIDS may be a predictive marker in the progression of AIDS or it may be the first clinical manifestation of HIV infection in children. Hence it is important for dentists to be aware of such lesions.
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candida spp in linear gingival erythema lesions in hiv infeceted children reports of six cases
International Journal of Science Dentistry, 2013Co-Authors: Maristela Barbosa PortelaAbstract:Linear gingival erythema (LGE), formally referred as HIV-gingivitis, is the most common form of HIV-associated periodontal disease in HIV-infection. These lesions were recently evaluated as a possible form of erythematous oral candidosis, mainly caused by Candida albicans. Other species are also being associated such as C. tropicalis, C. stellatoidea, C. krusei, C. parapsilosis, C. glabrata and C. dubliniensis, that was identified in some HIV-infected subjects. This case report demonstrates the presence of typical LGE lesions in six HIV-infected children, also investigates the etiologic agent by microbiological exams and correlates this oral manifestation with patients’ systemic conditions. Microbiological analyses showed positive growth for Candida spp in all patients, all of whom had severe imunessupression. After Antifungal Medication, the regression of lesions could be note. The presence of LGE in pediatric patients with AIDS may indicate its feature as a predictive marker in progression of HIV-infection in children.